Vein

For other uses, see Vein (disambiguation).

Cross section of a vein showing a valve which prevents backflow

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Anatomy

Veins generally function to return de-oxygenated blood to the heart, and are essentially tubes that collapse when their lumina are not filled with blood. The thick, outer-most layer of a vein is made of collagen, (Called 'Tunica Adventitia' or 'Externa') . Deep to this are bands of smooth muscle (Called 'Tunica Media'). This is generally thin as veins do not function primarily in a contractile manner. The interior is lined with endothelial cells (Called 'Tunica Intima'). Most veins have one-way flaps called venous valves that prevent blood from flowing back and pooling in the lower extremities due to the effects of gravity. These are in-foldings of the tunica intima. The precise location of veins is much more variable from person to person than that of arteries.

Function

Veins serve to return blood from organs to the heart. In systemic circulation oxygenated blood is pumped by the left ventricle through the arteries to the muscles and organs of the body, where its nutrients and gases are exchanged at capillaries, entering the veins filled with cellular waste and carbon dioxide. The de-oxygenated blood is taken by veins to the right atrium of the heart, which transfers the blood to the right ventricle, where it is then pumped through the pulmonary arteries to the lungs. In pulmonary circulation the pulmonary veins return oxygenated blood from the lungs to the left atrium, which empties into the left ventricle, completing the cycle of blood circulation.

The return of blood to the heart is assisted by the action of the skeletal-muscle pump which helps maintain the extremely low blood pressure of the venous system. Fainting can be caused by failure of the skeletal-muscular pump. Long periods of standing can result in blood pooling in the legs, with blood pressure too low to return blood to the heart. Neurogenic and hypovolaemic shock can also cause fainting. In these cases the smooth muscles surrounding the veins become slack and the veins fill with the majority of the blood in the body, keeping blood away from the brain and causing unconsciousness.

The arteries are perceived as carrying oxygenated blood to the tissues, while veins carry deoxygenated blood back to the heart. This is true of the systemic circulation, by far the larger of the two circuits of blood in the body, which transports oxygen from the heart to the tissues of the body. However, in pulmonary circulation the arteries carry deoxygenated blood from the heart to the lungs and veins return blood from the lungs to the heart. The difference between veins and arteries is their direction of flow (out of the heart by arteries, returning to the heart for veins), not their oxygen content. In addition, deoxygenated blood that is carried from the tissues back to the heart for reoxygenation in systemic circulation still carries some oxygen, though it is considerably less than that carried by the systemic arteries or pulmonary veins.

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Medical interest

Venous valves prevent reverse blood flow.

Veins are used medically as points of access to the blood stream, permitting the withdrawal of blood specimens (venipuncture) for testing purposes, and intravenous delivery of fluid, electrolytes, nutrition, and medications through injection with a syringe, or by inserting a catheter. In contrast to arterial blood which is uniform throughout the body, the blood removed from veins for testing can vary in its contents depending on the part of the body the vein drains; blood drained from a working muscle will contain significantly less oxygen and glucose than blood drained from the liver. However the more blood from different veins mixes as it returns to the heart, the more homogeneous it becomes.

If an intravenous catheter has to be inserted, for most purposes this is done into a peripheral vein near the surface of the skin in the hand or arm, or less desirably, the leg. Some highly concentrated fluids or irritating medications must flow into the large central veins, which are sometimes used when peripheral access cannot be obtained. Catheters can be threaded into the superior vena cava for these uses: if long term use is thought to be needed, a more permanent access point can be inserted surgically.

Common diseases

The most common vein disorder is venous insufficiency, usually manifested by spider veins or varicose veins. A variety of treatments are used depending on the patient's particular type and pattern of veins and on the physician's preferences. Treatment can include radio-frequency ablation, vein stripping, ambulatory phlebectomy, foam sclerotherapy, lasers or compression.

Deep vein thrombosis

Main article: Deep vein thrombosis

Deep vein thrombosis is a condition where a blood clot forms in a deep vein, which can lead to pulmonary embolism and chronic venous insufficiency.

Phlebology

Phlebology is the medical discipline that involves the diagnosis and treatment of disorders of venous origin. Diagnostic techniques used include the history and physical examination, venous imaging techniques and laboratory evaluation related to venous thromboembolism. The American Medical Association has added phlebology to their list of Self-Designated Practice Specialties. The American College of Phlebology is a professional organization of physicians and health care professionals from a variety of backgrounds. ACP Meetings are conducted to facilitate learning and sharing of knowledge regarding venous disease. The equivalent body for countries in the Pacific is the Australasian College of Phlebology, active in Australia and New Zealand.

Notable veins and vein systems

The Greater Saphenous vein (GSV) is the most important superficial vein of the lower limb. First described by the Persian physician Avicenna, Saphenous derives its name from Safina, meaning hidden. This vein is 'hidden' in its own fascial compartment in the thigh and only exits the fascia near the knee. Incompetence of this vein is an important cause of varicose veins of lower limbs.

The pulmonary veins carry relatively oxygenated blood from the lungs to the heart. The superior and inferior venae cavae carry relatively deoxygenated blood from the upper and lower systemic circulations, respectively.

A portal venous system is a series of veins or venules that directly connect two capillary beds. Examples of such systems include the hepatic portal vein and hypophyseal portal system.

Color

The blood carried by veins is dark red due to its high percentage of CO₂ as it returns to the heart (in contrast to the high levels of O₂ in arterial blood, which is bright red). Veins appear blue because the subcutaneous fat in the skin absorbs lower-frequency light, permitting only the highly energetic blue wavelengths to penetrate through to the dark vein and reflect off. This physical effect is also present in the iris of blue eyes (pigmentless iris in the front, dark retina in the back) and is called Rayleigh scattering.

Types of veins

Veins can be classified into:

• portal vein vs. non-portal (most common)
• superficial veins vs. deep veins
• pulmonary veins vs. systemic veins

List of important named veins

• Jugular veins
• Pulmonary veins
• Portal vein
• Azygos vein
• Superior vena cava
• Inferior vena cava
• Iliac vein
• Femoral vein
• Popliteal vein
• Great saphenous vein
• Small saphenous vein

Names of important venule systems

• Portal venous system
• Systemic venous system

See also

• Peripheral vein
• Deep vein
• Deep vein thrombosis
• Superficial vein
• Varicose veins
• Pulmonary circulation

External links

• Merck Manual article on veins.
• American College of Phlebology
• American Board of Phlebology
• American College of Phlebology Foundation
• Australasian College of Phlebology Information from the Australasian College of Phlebology Website
• In economics: Arterial and venous industries
• Animated Venous Access tutorials

Scientific publications

• Phlebology - international journal of venous diseases
• Phlebology: The Journal of Venous Disease